Harker David B, Turrentine Jake E, Desai Seemal R
The University of Texas Southwestern Medical Center, Dallas, Texas.
Medical College of Georgia at Augusta University, Augusta, Georgia.
J Clin Aesthet Dermatol. 2017 Apr;10(4):50-54.
A 34-year-old woman was referred to the authors' dermatology clinic for evaluation of right labial swelling and dyspareunia. Her symptoms began after receiving a liquid silicone injection into the buttocks at a cosmetic plastic surgery clinic that was operating illegally by an unlicensed provider. A single prior debulking surgery had produced only temporary relief of symptoms, and the swelling returned. Work-up including magnetic resonance imaging and skin biopsy revealed migration of the injected silicone from her buttock to the subcutaneous tissue of the right labia majora, with an associated granulomatous immune response to the silicone. To the authors' knowledge, the extent of contiguous soft tissue involvement shown in this case has not yet been reported in the medical literature, nor has the finding of migration from the buttocks to the vulvar tissues to produce such dramatic asymmetry. Treatment with intralesional steroids and minocycline was initiated with improvement noted at one-month follow-up. Large volume and adulterated silicone injections are associated with a host of complications, including silicone migration and granuloma formation. No consensus for treatment exists, but attempted therapies have included surgery, local steroid injections, systemic steroids, tetracycline antibiotics, and other immune modulators. Treatment must be tailored to the individual case, considering the patient's preferences and medical history.
一名34岁女性被转诊至作者所在的皮肤科诊所，以评估右侧阴唇肿胀和性交困难的情况。她的症状始于在一家由无执照提供者非法经营的整容整形诊所接受臀部液体硅胶注射之后。此前进行的一次减容手术仅暂时缓解了症状，肿胀又复发了。包括磁共振成像和皮肤活检在内的检查显示，注射的硅胶从她的臀部迁移到了右侧大阴唇的皮下组织，并伴有对硅胶的肉芽肿性免疫反应。据作者所知，该病例中所显示的连续软组织受累程度在医学文献中尚未见报道，从臀部迁移至外阴组织并导致如此明显不对称的情况也未见报道。开始采用病灶内注射类固醇和米诺环素进行治疗，在1个月的随访中可见病情改善。大量且掺杂的硅胶注射会引发一系列并发症，包括硅胶迁移和肉芽肿形成。目前对于治疗尚无共识，但尝试过的治疗方法包括手术、局部类固醇注射、全身性类固醇、四环素类抗生素以及其他免疫调节剂。治疗必须根据个体情况进行调整，同时考虑患者的偏好和病史。
